Background
In staged liver resections, associating liver partition and portal ligation for staged hepatectomy (ALPPS) achieves sufficient hypertrophy of the future liver remnant (FLR) in 7 days. This ...is based on portal vein ligation and transection, and on occlusion of intrahepatic collaterals. This article presents a new surgical technique for achieving rapid hypertrophy of the FLR, which also involves adding intrahepatic collateral occlusion to portal vein transection.
Methods
Patients scheduled for two‐stage liver resection for primary or secondary liver tumours, in whom the FLR was considered too small, were enrolled prospectively. In the first stage, a tourniquet was placed around the parenchymal transection line, and the right portal vein was ligated and cut (associating liver tourniquet and portal ligation for staged hepatectomy, ALTPS). The tourniquet was placed on the umbilical ligament if a staged right trisectionectomy was planned, and on Cantlie's line for staged right hepatectomy.
Results
From September 2011, 22 ALTPS procedures were carried out (right trisectionectomy in 15, right hepatectomy in 7). Median FLR at 7 days increased from 410 to 700 ml (median increase 61 (range 33–189) per cent). The median duration of the first stage was 125 min and no patient received a blood transfusion. The median duration of the second stage was 150 min and five patients required a blood transfusion. Fourteen patients had complications, most frequently infected collections, and five patients developed postoperative liver failure. Two patients died.
Conclusion
The ALTPS technique achieved adequate hypertrophy of the FLR after 7 days. It may provide a less aggressive modification of the ALPPS procedure.
Simplification of the ALPPS procedure
We compute the general expression of the one-loop vertex correction in an arbitrary plane-wave background field for the case of two on-shell external electrons and an off-shell external photon. The ...properties of the vertex corrections under gauge transformations of the plane-wave background field and of the radiation field are studied. Concerning the divergences of the vertex correction, the infrared one is cured by assigning a finite mass to the photon, whereas the ultraviolet one is shown to be renormalized exactly as in vacuum. Finally, the corresponding expression of the vertex correction within the locally constant crossed field approximation is also derived and the high-field asymptotic is shown to scale according to the Ritus-Narozhny conjecture, although the terms featuring the leading-order dependence on the field are found not to contribute to physical transition amplitudes.
Water pollution by metals and, in particular, acid mine drainage (AMD) is one of the most severe environmental problems to be faced by society. In this sense, treatment by membrane processes is a ...promising alternative, highlighting membrane distillation (MD) features to overcome the limitations of conventional processes. In this work, water gap MD (WGMD) and air gap MD (AGMD) were tested under different feed temperatures and organic matter concentrations, using 0.45 μm polytetrafluoroethylene (PTFE) membranes and real AMD from Tinto River, which is located in SW Spain.
For both MD modes, high permeate fluxes (up to 16.80 L h−1 m−2 for WGMD and 10.16 L h−1 m−2 for AGMD) were reached and over 99% rejection was obtained for electrical conductivity, ions and metals (Na+, K+, Ca2+, Mg2+, F−, Cl−, NO3−, SO42−, Cu, Fe, Zn, Cd, Co, Mn, Ni). In addition, specific thermal energy consumption (STEC) per unit of permeate water was calculated to obtain MD heat requirements. Furthermore, MD efficiency in terms of heat recovery was estimated by gained output ratio (GOR) between useful and total heat of the system. On that basis, MD and specifically the WGMD mode, showed great potential for the sustainable treatment of AMD.
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•Air and water gap membrane distillation (MD) were tested with acid mine drainage.•Influence of different feed temperatures and humic acid concentrations were studied.•Quantitative rejection of ions and metals was obtained for all experiments conducted.•Water gap MD showed greater performances of permeate flux and energy efficiency.
Overgrowth syndromes are characterized by global or localized disproportionate growth associated with other anomalies, including vascular malformations and neurological and/or visceral disorders. ...CLOVES (Congenital Lipomatous asymmetric Overgrowth of the trunk with lymphatic, capillary, venous, and combined‐type Vascular malformations, Epidermal naevi, Scoliosis/Skeletal and spinal anomalies) is an overgrowth syndrome caused by mosaic activating mutation in gene PIK3CA, which gives rise to abnormal PI3K‐AKT‐mTOR pathway activation. These mutations are responsible for the clinical manifestations of the syndrome, which include low‐ and high‐flow vascular malformations, thoracic lipomatous hyperplasia, asymmetric growth, and visceral and neurological disorders. These common anomalies are illustrated with figures from two personal cases. Identification of the clinical and genetic characteristics of CLOVES syndrome is crucial for the differential diagnosis with other overgrowth syndromes, such as Proteus or Klippel–Trenaunay (K–T) syndromes, and for the therapeutic management of the different anomalies. In this context, a new entity comprising different syndromes with phenotypic mutations in PIK3CA has been proposed, designated PIK3CA‐related overgrowth spectrum (PROS), with the aim of facilitating clinical management and establishing appropriate genetic study criteria.
PIK3CA pathway and syndromes. Left asymmetric overgrowth and sandal gap.
Transition metals are required cofactors for many proteins that are critical for life, and their concentration within cells is carefully maintained to avoid both deficiency and toxicity. To defend ...against bacterial pathogens, vertebrate immune proteins sequester metals, in particular zinc, iron, and manganese, as a strategy to limit bacterial acquisition of these necessary nutrients in a process termed “nutritional immunity.” In response, bacteria have evolved elegant strategies to access metals and counteract this host defense. In mammals, metal abundance can drastically shift due to changes in dietary intake or absorption from the intestinal tract, disrupting the balance between host and pathogen in the fight for metals and altering susceptibility to disease. This review describes the current understanding of how dietary metals modulate host-microbe interactions and the subsequent impact on the outcome of disease.
Transition metals are necessary nutrients and key players at the host-pathogen interface. In their review, Lopez and Skaar describe the multi-faceted ways in which dietary metal availability influences bacterial virulence and the host response to infection.
Abstract
The global pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains a challenge for prevention due to asymptomatic or ...paucisymptomatic patients. Anecdotal and preliminary evidence from multiple institutions shows that these patients present with a sudden onset of anosmia without rhinitis. We aim to review the pathophysiology of anosmia related to viral upper respiratory infections and the prognostic implications. Current evidence suggests that SARS-CoV-2-related anosmia may be a new viral syndrome specific to COVID-19 and can be mediated by intranasal inoculation of SARS-CoV-2 into the olfactory neural circuitry. The clinical course of neuroinvasion of SARS-CoV-2 is yet unclear; however, an extended follow-up of these patients to assess for neurological sequelae, including encephalitis, cerebrovascular accidents, and long-term neurodegenerative risk may be indicated.
There is increasing interest in the influence of place on health, and the need to distinguish between environmental and individual level factors. For environmental-level factors, current evidence ...tends to show associations through cross-sectional and uncontrolled longitudinal analyses rather than through more robust study designs that can provide stronger causal evidence. We restricted this systematic review to randomised (or cluster) randomised controlled trials and controlled before-and-after studies of changes to the built environment. Date of search was December 2016. We identified 14 studies. No evidence was found of an effect on mental health from ‘urban regeneration’ and ‘improving green infrastructure’ studies. Beneficial effects on quality-of-life outcomes from ‘improving green infrastructure’ were found in two studies. One ‘improving green infrastructure’ study reported an improvement in social isolation. Risk-of-bias assessment indicated robust data from only four studies. Overall, evidence for the impact of built environment interventions on mental health and quality-of-life is weak. Future research requires more robust study designs and interdisciplinary research involving public health, planning and urban design experts.
•Comprehensive systematic review of built environment interventions & mental health.•Weak evidence for the impact of built environment interventions on mental health.•Guidance on reducing risk of bias for these studies is provided.•Strategies, using innovative methods, are needed to improve evidence in this field.
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•The proposed pH sensor combines PAni chemical deposition and tilted fiber Bragg gratings.•In situ chemical oxidative polymerization track of the coating thickness allows to optimize ...the sensor response.•Determination of the sensor performance in terms of sensitivity and hysteresis between 2 and 12pH.•Fast response time and stabilization times comparable to commercial available devices.•Sensors present biochemical compatibility, temperature independence, long-term stability and remote real-time multipoint sensing features.
In this paper, we report an optical fiber pH sensor based on a polyaniline coating deposited on the surface of a tilted fiber Bragg grating. The pH-sensitive film was synthesized by in situ chemical oxidative polymerization keeping track of the deposition time in order to optimize the sensor response. As a result, the sensor reacts to pH changes in the range of 2–12 with a fast response and its sensitivity is directly related to the film thickness. The main advantages of this PAni-TFBG pH sensor are its biochemical compatibility, temperature independence, long-term stability and remote real-time multipoint sensing features.
While the QED photon amplitudes at full momentum so far have been calculated only up to the six-photon level, in the low-energy limit there are explicit formulas for all helicity components even at ...the N-photon level, obtained by Martin et al. in 2002. Here we use the worldline formalism to extend that result to the N-photon amplitudes in a generic constant field. For both scalar and spinor QED, we obtain compact representations for the low-energy limits of these amplitudes involving only simple algebra and a single global proper-time integral with trigonometric integrand.
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